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Pressure sores and perforating ulcer of the foot are the most important trophic phenomena. Apart from the medical treatment, measures must be taken to prevent deformity, especially when the legs are affected. The bedclothes are supported by a cage, and the foot maintained at right angles to the leg by sand-bags or splints.
The degeneration in the central end of the divided nerve is usually limited to the immediate proximity of the lesion, and does not even involve all the nerve fibres. In the distal end, it extends throughout the entire peripheral distribution of the nerve, and appears to be due to the cutting off of the fibres from their trophic nerve cells in the spinal medulla.
Meanwhile the pressure thus exerted on the nervi vasorum sets up vascular changes which bring about epithelial changes in more distant areas, the process advancing anteriorly, that is, in the direction of the arteries. This makes the cause, according to Eyles, an inflammatory and trophic phenomenon due mainly to changes following pressure on the vasomotor nerves. Etiology.
According to Crocker in some cases they can be shown to be a part of trophic changes. Bielschowsky records the case of a man with peripheral neuritis, in whom white spots appeared at the lower part of the finger-nails, grew rapidly, and in three weeks coalesced into a band across each nail a millimeter wide. The toes were not affected.
In this manner they explain burns through suggestion, stigmata, trophic changes of a miraculous appearance, etc. It is needless to dwell on this conception of the unconscious.
For example, trophic ulcers are liable to occur in injuries or diseases of the spinal cord, in cerebral paralysis, in limbs weakened by poliomyelitis, in ascending or peripheral neuritis, or after injuries of nerve-trunks.
In the sciatica that results from neuritis and perineuritis, there is marked tenderness on pressure due to the involvement of the nerve filaments in the sheath of the nerve, and there may be patches of cutaneous anæsthesia, loss of tendon reflexes, localised wasting of muscles, and vaso-motor and trophic changes. The presence of the reaction of degeneration confirms the diagnosis of neuritis.
Those affected become soft and flaccid, exhibit tremors on attempted movement, and their excitability to the faradic current is diminished. Neuropathic atrophy is associated with lesions of the nervous system. It is most pronounced in lesions of the motor nerve-trunks, probably because vaso-motor and trophic fibres are involved as well as those that are purely motor in function.
Wasting of muscles is a constant accompaniment of tuberculous joint disease. It is to be attributed partly to want of use, but chiefly to reflex interference with the trophic innervation of the muscles. It is specially well seen in the extensor and adductor muscles of the thigh in disease of the knee, and in the deltoid in disease of the shoulder.
Some of the students of hypnotism are inclined to go as far as to admit organic change under hypnotic suggestion. "Strong, persistent impressions or suggestions made on the reflex organic consciousness of the inferior centers may modify their functional disposition, induce trophic changes, and even change organic structures."